Health: Sepsis

Lord Winston Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I am very happy to congratulate the BBC. I do not know that I heard “The Archers” storyline in question, but I shall make sure that I update my education in this respect. I want also to congratulate Public Health England on its national Start4Life information service for parents. It has worked with Mumsnet to make sure that awareness is spread to those most likely to need it, because those most at risk are the young, the elderly and those who have underlying conditions. Targeting the messaging at those who need it most is very important.

[Lord Winston (Lab)]

My Lords, the noble Lord, Lord Grade, raises a very important point. Can the Minister tell us what percentage of patients with sepsis have the DNA profile of the bacteria recorded?

[Baroness Blackwood of North Oxford]

The noble Lord, Lord Winston, always raises very specific questions requiring statistical answers which are not necessarily at my fingertips. I shall write to him on that point.

Health: Eating Disorders

Lord Winston Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

Obviously we cannot ignore the obesity challenges that we face in this nation, and it is right that we take strong action to address them. But we recognise that this must be done in a sensitive way that also takes into account the potential consequences for those with eating disorders. We must strike a careful balance between informing and educating people about healthier choices and not negatively impacting on those with eating disorders, those in recovery from eating disorders or those who have the potential to develop them.

[Lord Winston (Lab)]

My Lords, the figures are, of course, of great concern but, as so often happens with many pathologies, sometimes the reasons for these sudden or increased rises are due to better diagnosis or increasing diagnosis, and, of course, greater awareness of the problem. Given that, can the noble Baroness say what plans the Government have to ensure that NHSX is fully supported in trying to help us to analyse these data to see just how important investment in this particular condition actually is, and others similarly that are on the rise?

[Baroness Blackwood of North Oxford]

The noble Lord, as ever, is quite right to delve into the detail of the 2017 survey into the mental health of children and young people in England. It found that eating disorders were identified in 0.4% of five to 19 year-olds—the spread was 0.7% of girls and 0.1% of boys—but it rose to 1.6% of girls aged seven to 19. Obviously, we want to understand what this rise in admissions means. There could be a number of reasons, which we hope are linked to earlier and better diagnosis, but of course we need to understand it better. We have a much better understanding of the data through the NHS mental health dashboard, which tracks down to CCG level what is happening with it, but we need to make sure that this work is properly funded and properly tracked in order to lead to better and more effective policies and provision of commissioned services.

Health: Tick-borne Encephalitis

Lord Winston Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right, and I am happy to recognise the organisation that she mentioned. In the first place, the tick toolkit and the work of PHE is in place to raise awareness, and work goes into providing advice to professionals so that early diagnosis is possible.

[Lord Winston (Lab)]

My Lords, one of the problems with Lyme disease is that the symptoms that it causes mimic a whole range of different viral infections, many of which are much more common. Does the Minister feel that the Government are doing enough to raise awareness of Lyme disease among general practitioners, and is she satisfied that the screening tests—I think that they cost around £60 a time—are sufficient?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right, and he understands this a lot better than I do. NICE published guidelines for health professionals in 2018 in an effort to ensure prompt diagnosis of Lyme disease. Obviously if it is recognised promptly and treated with antibiotics, acute Lyme disease is usually resolved without further complications. I will take away the question about the cost of the test to consider whether that has been a barrier; we have no evidence about that at this time.

Sexually Transmitted Infections: England

Lord Winston Excerpts

Thursday 5th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that increases in particular STIs are worrying and we need to make sure that we drive forward our response to that. Some BAME groups are at particularly high risk of STI acquisition, particularly those from a black Caribbean background possibly due to a higher number of sexual partners. PHE’s reproductive, sexual health and HIV innovation fund is spearheading new, innovative, community-led interventions to support those at increased risk of infection and we will continue to look for new ways to respond to these challenges.

[Lord Winston (Lab)]

My Lords, it is very unwise to group all STIs together and the organism that I should like to concentrate on for the moment is chlamydia. We may not be diagnosing chlamydia in the right way. Given that the NICE guidelines now mean that we hardly ever do laparoscopies, we cannot show whether people have tubal damage, which is said to be an important part of chlamydia. In my view, that is greatly overestimated. What does the Minister think about research into whether chlamydia really does cause infertility and other problems with conception?

[Baroness Blackwood of North Oxford]

The noble Lord is of course an expert in where we should target our research. The NIHR is a £1 billion fund which is not targeted specifically. However, it is right that we should target research into STIs to ensure our response to the challenges. We know that STIs are increasing so we should include research into them.

GP Partnership Review

Lord Winston Excerpts

Thursday 21st February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: we want to free up GPs to do exactly what they have been trained to do, which is to care for patients. That is why, as part of the GP contract, we have included funding to ensure that they can claim for any additional costs that they may have under the GDPR. It is also why we put in the long-term plan that we want to recruit an extra 20,000 staff who can provide the other services, such as administrative services, that GPs are sometimes caught up doing when they should not be.

[Lord Winston (Lab)]

My Lords, the list of things that the Government intend sounds very impressive. I have a simple question. Communication is particularly important to general practitioners, who may see 90 or 100 patients with abdominal pain, one of whom may have a cancer of the colon. That is one of the major problems. Has the noble Baroness ever sat down and had informal conversations with general practitioners who are threatening to retire, or are retiring, early to understand how they feel about it?

[Baroness Blackwood of North Oxford]

I absolutely have had a large number of conversations with general practitioners who have struggled. In my previous role as a Member of Parliament, I visited a large number of general practices in my constituency. I am also the daughter of a doctor and I have a rare disease, so I spend a lot of time in the NHS as a patient and, perhaps, as a mystery shopper—so I assure the noble Lord that I have extensive experience of the NHS. I would not claim, however, to understand what it is like to be a general practitioner, so I would always hope to learn by continued experience of listening to their experiences and challenges.

Healthcare (International Arrangements) Bill

Lord Winston Excerpts

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Lord O’Shaughnessy]

My Lords, the reason is that the statute by which we are able to strike reciprocal healthcare agreements—the regulations stated in the Explanatory Notes—comes from the body of EU law. Without that we are not able to have reciprocal agreements with anyone, so in that sense we are replacing the source of our law with a different source. It does not follow that with the law we have in place, we should restrict ourselves to having arrangements with a subset of the countries where we could do so.

[Lord Winston (Lab)]

I have the greatest respect for the noble Lord, Lord O’Shaughnessy, who we feel did a great job while he was in the department as a Minister, but does he not see that this is indeed a Brexit Bill? Out there in the community, people voting in the referendum said, “Take back power”. It was about taking back control and the paradox in this amendment—it may be irony, I am not quite sure which—is that we are not taking back control. Parliament will not have the control, which is what the people wanted at the time of voting for Brexit. That is fundamentally wrong and inappropriate, therefore I am quite certain that this amendment is appropriate.

[Lord O’Shaughnessy]

That is a separate issue. As I said at the beginning, the issue here is actually in two parts. The first is whether we ought to use the new legislation to strike deals with a subset of countries, those with which we already have reciprocal deals through our membership of the EU, or to strike broader ones. The secondary question is: what ought to be the correct process for Parliament to provide scrutiny of the kind of deals that are set up, either to provide continuity with the ones that we have under the EU or with new partners? Those are different questions. It is up to this Committee to make its decision about what it feels is the appropriate route to go forward, but it is important to expose that those are different and separate questions and we ought to consider them as such.

Perhaps I may respond to the point made by the noble Baroness, Lady Andrews, and others about trade. It is absolutely not the case that this is some Trojan horse for privatisation of the NHS, as the noble Lord, Lord Brooke, said, or anything else. My noble friend the Minister made that completely clear in her letter, as I used to in the letters that I once sent the noble Lord as well. Consider this: one of the reasons that we have deep reciprocal healthcare agreements with EU countries is due to the fact that we are part of a large trading bloc called the European Union. It is perfectly normal for partners engaged in economic, social, cultural, scientific and other activities to have these kind of agreements, partly because they facilitate the movement of people from one to another, whether on holiday or for work and other things.

I would hope, regardless of whether we were leaving the European Union or not, that we would want to have these kind of agreements with our partner countries throughout the world. Regardless of one’s views on Brexit, we ought to want to do that. It is not something that we have the legal basis to do at the moment and the Bill gives us that. I want to correct the impression given by the noble Baroness, Lady Andrews, which I do not think is fair, that this is somehow a Trojan horse for some sort of nefarious agenda. That is absolutely not the case; it is about taking a broader view of the kind of relationships that we currently enjoy with the EU and want to enjoy with other countries, whether they are Commonwealth partners or the overseas territories and Crown dependencies noted by my noble friend Lord Ribeiro.

I hope that I have described clearly what I believe the intent is in this regard. It is absolutely noble and will facilitate the broader movement of people throughout the world.

Human Fertilisation and Embryology (Parental Orders) Regulations 2018

Lord Winston Excerpts

Wednesday 12th December 2018 Grand Committee

I hope that I have given a thorough introduction to the content and purpose of the instruments and I hope they will be welcomed by the Committee. I beg to move.

[Lord Winston (Lab)]

My Lords, forgive me for a brief intervention. I do not have any problems at all with the basic notion of what is in front of us. It is possible that I was the first person to do a surrogacy agreement using IVF, so I have a certain amount of background in this rather murky subject.

One thing that slightly concerns me is the issue of paternity or maternity genetically, because we now have a situation where children can normally trace their genetic parent. That is on the birth certificate. Here we have a slightly odd situation. For example, particularly with a gay or lesbian couple, or where someone has not only had their uterus but their ovaries removed, someone may end up receiving a donor egg which is then implanted into the surrogate mother after fertilisation. So an embryo could be put into a surrogate mother who is happy with that, but it is not genetically her embryo.

I am just trying to raise the issue of clarity. Given that Parliament in its wisdom decided that people should be able to trace their genetic mothers, someone who had given an egg in that situation could suddenly be presented with a child they did not know they had, even though their own treatment had failed 20 years or earlier. When the Minister wraps this up, can he provide some clarity on what would happen, because there is human rights issue both ways here?

[Baroness Barker (LD)]

My Lords, I thank the Minister for introducing this debate in the way that he did and giving the background to the instruments before us today. I should declare that I am a member of the All-Party Parliamentary Group on Surrogacy. I have a long-standing interest, fuelled by many a night sitting listening to the noble Lord, Lord Winston, as we went through various bits of legislation but principally by the work done by Surrogacy UK in 2016 when it produced a report. There was a debate in December of that year. Baroness Warnock was no longer a Member of your Lordships’ House, but the noble and learned Lord, Lord Mackay of Clashfern, was. Those of us who had been involved in legislation on this matter from the beginning in the 1980s accepted that the overall legislative framework we now have is not really fit for purpose, not least because of the many scientific advances that have happened in the intervening years. As the noble and learned Lord, Lord Mackay, observed in that debate in 2016, there are now many more ways in which families, as well as children, are created.

The Minister was right that the original stimulus for the legislation was the case of a man who in 2015 had a child by surrogacy abroad, brought the child back and found that the child’s status was incompatible with our law at the time, which stated that parental orders could be made only in respect of a couple. That was two and a half years ago. In the meantime, others have found themselves in similar limbo. The courts have had to make what are essentially temporary orders. Those orders are above all for the welfare of a child: a child is being cared for by somebody who is not their legal parent and has no legal responsibility for them. We should not lose sight of that.

This measure is a welcome step forward which offers a degree of certainty not only to individual parents or intended parents who find themselves in this position but to the children. I am pleased that the Law Commission is now undertaking an extensive review of the legislation. The All-Party Parliamentary Group on Surrogacy is conducting its own hearings on the matter. For just a small all-party group, the hearings have been extremely interesting. We have had a huge number of people give evidence, some with very conflicting views. I think that we will end up with an interesting report that feeds into that work. My guess is that the Law Commission will take about two years to produce a report.

My reason for mentioning all that is that time ticks by for individuals as we debate these matters. I do not suggest for a moment that we should do anything in a rush, but, at the same time, it is incumbent on us to deal with some matters urgently, because to do so is in the interest of individuals.

There are some ways in which a single person applying for a parental order will be still be left outside these remedial orders. I understand that a case is before the courts at the moment of a woman whose relationship with the biological father of a child has broken down. She is now in the position of being a single person who has no biological relationship with the child but nevertheless wishes to have parental responsibility. Another tragic case is before the courts in which one member of a couple has died subsequent to the fertilisation process having taken place.

However long the Law Commission takes to do its work, which it should do extensively and thoroughly, I think that we will continue over the years to have a small number of cases that are intensely important both for intended parents and for children. It is therefore likely that we will find ourselves back in this House making more revisions of regulations of this kind before we get the comprehensive review of surrogacy law that we need so that practitioners, medics, intended parents and children all have a better understanding of where we should be legally in this day and age.

--- Later in debate ---

[Lord O’Shaughnessy]

I am very grateful to all noble Lords who have spoken. One of the great joys of working in this House is that we are privileged to have access to such expertise, be it scientific, policy or legislative. We have had a very good, if short, debate in which there were some interesting questions which I shall try to answer. The noble Lord, Lord Winston, made a point about tracing the genetic parents in the case of a donated gamete. I shall read out what it says in my pack to make sure that I get the wording right and then I am going to make an addendum which I think is also correct.

If a child is conceived via an HFEA-licensed clinic with donor gametes, it may be able to access information about the donor in line with the responsibility of the clinic to provide information under the HFE Act, but this would depend on the parents informing the child of the circumstances of their birth. Of course, that would be so that the child was aware that they could ask, but at the point at which they became aware, via their parents or anyone else, they would then have a right to that information. I think the point the noble Lord made was that however the line goes to the genetic forebear, the child would have the right to pursue it. Of course, it would rely on the child being aware of the circumstances of their birth and so on, and we cannot force that on somebody, but they would be able to trace it.

[Lord Winston]

Does that mean that the birth certificate would be like a normal birth certificate under those circumstances?

[Lord O’Shaughnessy]

Yes, because the court retains a copy of the original birth certificate. I am going to need to clarify this because it is tricky and there is a danger if I try to describe it now. I do not want to do that. I think the noble Lord is asking for clarification, but I am going to need to write to him, if he will accept that, to clarify the situation.

[Baroness Barker]

I hope I am going to be helpful. If I am right, I think that at the point at which a parental order is given, a new birth certificate is issued. That rather mirrors the procedure under adoption, which is the same. The point is that a child always has the right to find out their genetic history but they may not know the means of their birth. From all the things that I have listened to in this House, that makes them probably like a good 40% of people who were not adopted or the result of fertilisation but who have a different father from the one they thought they had; I do listen.

[Lord Winston]

I do not want to delay things, but surrogacy is a special situation because the child is developed in another uterus, so there are epigenetic factors which may act on that child’s development. We are now beginning to understand—for example, from the study that I am involved with in Singapore—that things which happen when the baby is in utero can affect cognitive development and other sorts of development later in life. It is therefore slightly different from a normal donated gamete in a usual IVF setting or simple artificial insemination. That is why I wondered whether there will be clarity about the exact nature of the bearing mother as opposed to the genetic mother, because that seems to be important. Is that recorded on the certificate?

The NHS

Lord Winston Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Winston (Lab)]

My Lords, it is a great pleasure to congratulate my noble friend—and respected colleague at Imperial College—Lord Darzi on the outstanding way he introduced the debate. I was just talking to the noble Lord, Lord Reid, in the Bar and he said that sometimes you tear up the speech that you have written. This is one of those occasions.

At 8.40 am today, my grandson was born at Queen Charlotte’s and Chelsea Hospital under the National Health Service. My daughter had a horrendous pregnancy four years ago. I went through every single red light in London, I think, on my way to Queen Charlotte’s, when she had the most serious obstetric emergency and could have died. In fact, both she and the baby, Ellie, survived and are well, and she had this last pregnancy by elective caesarean section. It is striking that the National Health Service has been an example of the most amazing care. When I took her into Queen Charlotte’s the first time, she was delivered within 13 minutes of arrival on site and they did not even recognise me, even though I had helped design the building in which she was being delivered. That is a great credit to the health service.

Today there was a slightly different welcome when I drove up to the car park. It was completely blocked by television cameras, with various news media filming Queen Charlotte’s in all its panoply of glory, accompanied by wonderful, syrupy comments about the National Health Service. While I was hoping to hear a baby cry in the operating theatre next door, I was watching the coverage on television as an example of exactly what we do not need. My noble friend Lord Darzi was completely right, in the humble way he introduced the debate, to point out how magnificent the health service has been, but it is also important for us to be realistic. There is a major problem that we have to face and it is often easy to be really quite untruthful about the impact.

We are not having a proper debate about the health service in this country. I mean no disrespect to the Prime Minister or anybody else but we cannot continue on handouts. Both parties have been equally responsible. We always claim on this side that we invented the health service. I remember that when the dreadful internal market was brought in by Margaret Thatcher, Frank Dobson, the shadow Health Minister, promised he would abolish it. He did not when we came into power. We still have that iniquitous system, which is costing the National Health Service millions in bureaucracy and all sorts of other things, and of course resulting in health inequality, with the postcode lottery and many other examples.

We have to recognise that we need to have an honest debate and the only way we can do this is to depoliticise the system and the argument. We have to recognise that on all sides of this House we agree about the value of the National Health Service. We all realise that it is a remarkable and unique but fragile organisation. We need to do something about recognising that first we have to agree on a proportion of gross domestic product to understand how we are going to fund it before we consider taxation or any other form of spending. We have to understand how much it actually costs and at the moment, with that internal market, sadly, we do not know that. That is a major problem for us and something that I hope we will look at.

My noble friend Lord Darzi reiterated a very important point that I made in a debate about a month ago when I pointed out the importance of academic healthcare and the academic science centres. This is something which really is unique in the health service and unless we continue with that aspect of science, there will be a problem. So we have to weigh that in the balance of how we fund the health service in the future.

Health: Endoscopy and Bowel Cancer

Lord Winston Excerpts

Monday 2nd July 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for raising that question and am sorry to hear about her mother. As she will know, bowel cancer is unfortunately the third-most prevalent cancer and the second-biggest killer, and we need to go a long way to improve treatment. I have already mentioned the increase in the number of endoscopists, and that will help. There are also plans to make sure that existing staff within the cancer workforce have the necessary specialist skills. The size of the cancer workforce has increased over the last few years but there is a goal to dramatically increase it further. We know that the test that the noble Baroness mentioned is much more effective and can be administered much more easily. The rollout will take place from December this year.

[Lord Winston (Lab)]

My Lords, there is an increasing interest in capsule endoscopy, which of course is less invasive as it does not require an instrument to be put down into the abdomen. However, it requires training, which the medical literature clearly shows is insufficient. Can the Minister indicate whether the NHS is planning to provide more training for the provision of capsule endoscopies? Also, what is the risk of a large number of false positive results with all these endoscopies?

[Lord O'Shaughnessy]

I will have to write to the noble Lord with an answer to his question about the type of endoscopy he mentions, as I do not have the details of it. The risk of false positives is one reason that we have to be extremely careful with screening programmes of all kinds, whether it is the faecal immunochemical test or an endoscopy. As he knows, whatever screening programmes are implemented, the National Screening Committee tries to reduce the number of false positives wherever possible.

Health: Online Services

Lord Winston Excerpts

Monday 23rd April 2018 Lords Chamber

[Lord O'Shaughnessy]

That is an excellent point: the entire country is preparing for the advent of the GDPR on 25 May. We are engaged in a large programme of work with the Information Commissioner’s Office and others to ensure that everyone working in the health and care services understands their obligations and informs patients accordingly.

[Lord Winston (Lab)]

My Lords, a large number of reproductive clinics publish their wares by advertising on the London Underground, often at great cost, sometimes making claims about their treatments. If I did that as a doctor, I would be struck off the register. They get round it because they are private clinics. Is that appropriate? Does the Care Quality Commission have any involvement in this process, and should it?

[Lord O’Shaughnessy]

I would have to look at the specific clinics that the noble Lord is talking about. The subject of the report was those providing online services. One of the things it discovered was that certain regulatory issues are unique to the provision of online services, an example of which is when the data is held offshore and what that means for regulation. As the CQC says in its report, it is reviewing its regulations to make sure that it can account for the unique aspects of online provision, so that the critical aspects, whether they are about truthful advertising or other aspects, are dealt with properly.